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Prolonged Erection (Priapism): Causes, Symptoms and Treatment

What is priapism?

Priapism is an uncommon form of the penile erection, occurring even without any sexual stimulation and lasting for more than 4 hours. It requires emergency treatment and if left untreated, can lead to permanent erectile dysfunction and penile scarring.

Priapism: Persistent and often painful erection

Priapism is common in men in their 30s but can occur in any age group including newborns.

Causes

Priapism occurs primarily due to the entrapment of the blood in the spongy tissues of the penis (corpora cavernosa) and the blood doesn’t flow back.

Priapism can result from factors that impact the blood flow to the penis or parts of the nervous system which regulate the blood flow to it. Thus, priapism can be due to:

  • Sickle cell anaemia: It arises as a result of a genetic disorder where the red blood cells are crescent-shaped. Blood gets lodged in penis due to increased viscosity.
  • Medication: Many medications like anticoagulants or antipsychotic drugs can lead to priapism.
  • Other causes include:

• Trauma to genital area or spinal cord
• Carbon monoxide poisoning
• Street drugs like cocaine and marijuana

Symptoms

Priapism can be of the following types:

  • Low-flow (ischemic) priapism: Here the blood gets trapped in the erection chambers. Often, the cause is not known and can occur in men with leukaemia, sickle-cell disease or malaria. The symptoms include a rigid penis shaft and white, soft tip. It can manifest with pain as well.
  • High-flow (nonischemic) priapism: A rare form of priapism which is not painful. It occurs due to an injury to the penis or the genital region, preventing the normal blood circulation in the penis. Its symptoms include a not fully rigid but erect penile shaft.

Diagnosis

Priapism is a medical emergency needing immediate medical treatment. Your doctor will question about the medical history regarding the duration of symptoms, any medication intake or drug abuse or a history of trauma.

After a physical exam, blood from the penis will be taken to analyse the blood gases for determining the type of priapism.

An ultrasound using Doppler ultrasonography can be done to estimate the flow of the blood in the penile blood vessels.

A urine test can be ordered to find any drugs responsible for the condition.

Treatment

The treatment aims at reducing the abnormal penile erection. It also tries to ensure future erections. Medications are helpful if the treatment is sought within 4-6 hours.

Treatment of specific types of priapism include:

Treatment of low-flow (ischemic) priapism:

  • Intracavernous injection: Some medications are directly injected into the penis to make the blood vessels that carry blood out of the penis to open up and let the blood flow out. This treatment can be repeated if required.
  • Surgical shunt: A passageway (shunt) is surgically inserted into the penis to divert the blood and to permit blood circulation to normalcy.
  • Aspiration: Blood is drained from the penis using a needle, to reduce the swelling and pressure
  • Surgical procedures may be employed if other treatments are not helpful.

Treatment of high-flow (nonischemic) priapism:
Often this form of priapism resolves on its own. Ice packs applied on the perineum (region between the penis base and the anus) can be helpful in bringing down the swelling. Surgery will be done to address the ruptured arteries or tissues if the cause is an injury.

Prevention

In a few individuals, priapism episodes can reoccur. In such cases, avoiding certain medications, drugs or alcohol that trigger these events will be helpful in preventing the episodes. However, in most cases, priapism occurs suddenly, and it can’t be prevented.

Complications

Ischemic priapism can lead to serious complications. When the blood gets trapped, oxygen supply to the penis will be restricted, resulting in tissue damage in the penis. Hence, an untreated priapism can lead to erectile dysfunctions.

Red Flags

If emergency treatment is not obtained within 24 hours of onset of priapism, you can have problems in having future erections and have permanent damage to the penis.

Consult a top Urologist

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References

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  • Guideline on the management of priapism (2003). American Urological Association. https://www.auanet.org/education/guidelines/priapism.cfm. Accessed 25 Jul. 16.
  • NHSChoices. http://www.nhs.uk/conditions/Priapism/Pages/Introduction.aspx. Accessed 25 Jul. 16.
  • Cleaveland Clinic. http://my.clevelandclinic.org/health/diseases_conditions/hic_Priapism. Accessed 25 Jul. 16.

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